Goranitis Ilias, Bellanca Leana, Daley Amanda J, Thomas Adele, Stokes-Lampard Helen, Roalfe Andrea K, Jowett Sue
Health Economics Unit, University of Birmingham, Birmingham, United Kingdom.
Primary Care Clinical Sciences, University of Birmingham, Birmingham, United Kingdom.
PLoS One. 2017 Sep 26;12(9):e0184328. doi: 10.1371/journal.pone.0184328. eCollection 2017.
To compare the cost-utility of two exercise interventions relative to a control group for vasomotor menopausal symptoms.
Economic evaluation taking a UK National Health Service and Personal Social Services perspective and a societal perspective.
Primary care.
Peri- and postmenopausal women who have not used hormone therapy in the past 3 months and experience ≥ 5 episodes of vasomotor symptoms daily.
An individual and a social support-based exercise intervention were evaluated. The former (Exercise-DVD), aimed to prompt exercise with purpose-designed DVD and written materials, whereas the latter (Exercise-Social support) with community exercise social support groups. Costs and outcomes associated with these interventions were compared to those of a control group, who could only have an exercise consultation. An incremental cost-utility analysis was undertaken using bootstrapping to account for the uncertainty around cost-effectiveness point-estimates.
Cost per quality-adjusted life-year (QALY).
Data for 261 women were available for analysis. Exercise-DVD was the most expensive and least effective intervention. Exercise-Social support was £52 (CIs: £18 to £86) and £18 (CIs: -£68 to £105) more expensive per woman than the control group at 6 and 12 months post-randomisation and led to 0.006 (CIs: -0.002 to 0.014) and 0.013 (CIs: -0.01 to 0.036) more QALYs, resulting in an incremental cost-effectiveness ratio of £8,940 and £1,413 per QALY gained respectively. Exercise-Social support had 80%-90% probability of being cost-effective in the UK context. A societal perspective of analysis and a complete-case analysis led to similar findings.
Exercise-Social support resulted in a small gain in health-related quality of life at a marginal additional cost in a context where broader wellbeing and long-term gains associated with exercise and social participation were not captured. Community exercise social support groups are very likely to be cost-effective in the management of vasomotor menopausal symptoms.
比较两种运动干预措施相对于对照组治疗血管舒缩性绝经症状的成本效益。
从英国国家医疗服务体系和个人社会服务角度以及社会角度进行经济评估。
初级保健。
在过去3个月未使用激素疗法且每日经历≥5次血管舒缩性症状的围绝经期和绝经后妇女。
评估了一项个体运动干预和一项基于社会支持的运动干预。前者（运动DVD干预）旨在通过专门设计的DVD和书面材料促进运动，而后者（运动-社会支持干预）设有社区运动社会支持小组。将这些干预措施的成本和结果与对照组（仅能接受运动咨询）进行比较。采用自抽样法进行增量成本效益分析，以考虑成本效益点估计值周围的不确定性。
每质量调整生命年（QALY）的成本。
有261名女性的数据可供分析。运动DVD干预是最昂贵且效果最差的干预措施。在随机分组后6个月和12个月时，运动-社会支持干预每名女性比对照组分别贵52英镑（可信区间：18英镑至86英镑）和18英镑（可信区间：-68英镑至105英镑），并导致多获得0.006（可信区间：-0.002至0.014）和0.013（可信区间：-0.01至0.036）个QALY，分别得出每获得一个QALY的增量成本效益比为8940英镑和1413英镑。在英国背景下，运动-社会支持干预有80%-90%的概率具有成本效益。从社会角度进行分析和采用完整病例分析得出了相似的结果。
在未考虑运动和社会参与带来的更广泛幸福感和长期收益的情况下，运动-社会支持干预在边际额外成本的情况下使健康相关生活质量略有提高。社区运动社会支持小组在管理血管舒缩性绝经症状方面很可能具有成本效益。
